AFTER AN ACCIDENT.
CARTER'S SUDDEN DEATH.
(By Telegraph. — Own Correspondent.) DUNEDIN, this day. Thomas Peattie Kirk, married, aged 42, a carter employed by the New Zealand Express Company, was admitted to the hospital on Thursday last, suffering from injuries to the leg by falling from a lorry, and was discharged after three days, though still undergoing treatment as an outpatient. He died suddenly last night. The inquest was adjourned for a post-mortem. -Auckland Star, 17/7/1924.
His Last Tragic Journey
Broken Leg Ends In Death
Walking Treatment for Fractures — What Caused the Fatal Embolism?
Who is to Blame for Sending Broken-Legged Man to Hobble Home from Hospital?
(From "Truth's" Dunedin Rep.)
Is it sound medical practice to allow a broken-legged man to walk within a day or two?
If so, should he be allowed to walk a distance of nearly 400 yards from hospital to his home?
If the Dunedin Hospital authorities were justified in letting Thomas Kirk walk at all, were they justified in letting him leave the hospital except in a conveyance?
Was the embolism that subsequently killed him caused (directly or indirectly) by being prematurely on his feet, by the exhausting walk home, or by what?
Is X-ray essential to diagnosis of fractures, .or to examination of fractures before discharge?
If so, should a hospital have a standby X-ray set?
The administration of affairs in connection with the public hospital in Dunedin, as is probably the case with other similar institutions, has not always shown up in a favorable light, and just now public indignation in Dunedin is touching fever heat as a result of certain facts revealed at the inquest on the body of Thomas Peattie Kirk, who died recently at a boardinghouse in Castle Street, where he lived with his wife and child. Deceased was a carter employed by the New Zealand Express Company, and was admitted to the .Hospital on Thursday, July 10, suffering, from a fracture of the left leg caused through a fall from a lorry while working at the wharf. Two days after his admittance he was discharged from, the institution, and actually walked to his home, a distance of nearly 400 yards.
That tragic, agonising journey took an hour and a quarter to cover! On the Wednesday night following (July 16) he died.
What everyone is asking is whether the patients are the first or the last consideration in the order of things.
At the inquest, Mr. J. R. Bartholomew, S.M., acted as coroner. Mr. A. C Hanlon represented the widow, and Mr. A. C. Stephens appeared for the New Zealand Express Company. Dr. A. R. Falconer (medical superintendent of the hospital) represented the hospital authorities, and Sergeant Gilligan the police.
WIDOW'S PITIFUL STORY. Isabella Kirk, wife of deceased, gave evidence as to his painful progress home from the hospital, and subsequent collapse and death, after being attended at his home by Dr. Gerald Fitzgerald. On the way home, deceased became faint, and the perspiration was pouring from him. On the Sunday she rang Dr. Gerald Fitzgerald, asking him to call next morning. He did so. Dr. Fitzgerald came again on the Wednesday morning, when her husband was in good spirits and free of pain. At 7.46 that night, however, he took a fit of vomiting, and witness sent for the doctor. He came almost immediately, but deceased collapsed just as he came in the door. He was a strong, able-bodied man, and had never had a day's illness during their married life.
Dr Philip Patrick Lynch, clinical pathologist at the Otago University, said, that on July 7 he made a post mortem examination of the body, which was that of a well-nourished, muscular man. A clot of blood had formed in one of the leg veins as a result of the laceration of the vein by the bone ends. Loose pieces of the clot had gained access to the general circulation, and one fragment, had lodged on the left lung. That was the cause of death.
To Mr. Stephens: The laceration of the vein probably took place at the time of the accident. It was difficult to say whether it took place as the man went home from the hospital. Death from embolism was not a common complication of common fractures. Anything that tended to disturb the limb would probably tend to dislodge fragments from the clotted vein.
To Mr. Hanlon: It would be impossible before death to tell by examination that clotting had taken place. There would be nothing to show that there was laceration of the vein, as in any case the leg would be discolored and swollen.
Mr. Hanlon: Is it prudent to have a man with his shin bone broken hobbling about on crutches within 48 Hours of the fracture?
Witness: That is purely a question of treatment. I cannot give an opinion, but there seems to be a growing tendency to treat fractures by keeping the patient going about
And take the risk of embolism causing the man's death?
It is a question of estimating risks. It is the opinion of some medical men that on account of the limited damage in simple fractures, these patients can be got up within a few days.
NOT QUARTER MILING But does that include sending them for a jaunt on crutches for a quarter of a mile? — No, I don't say that.
Doesn't it seem an imprudent thing to do? — That is again a question of treatment.
Is that what you would do in the circumstances? — No. I wouldn't do it In a case of mine.
Would death have been as likely to ensue if the man had been kept in his bed instead of being sent home on crutches? — I don't think it is possible to say. On general principles I would rather be in bed if I were in that condition.
The Coroner: Would any violent exertion or movement cause added danger to the clots breaking away? — Yes. In the case of a threatened embolism, part of the treatment would be rest and quiet.
Mr. Hanlon: It would be much more painful to go about than to lie in bed? — Yes.
To Dr. Falconer: Movement would be liable to dislodge the clot immediately, and as this took place on the Wednesday, and he was discharged on the Saturday, he thought it was extremely unlikely that dislodgment took place as the man went home. It was only a matter of seconds after dislodgement that plugging in the lungs occurred.
X-RAY PLANT OUT OF ORDER. Dr Gerald Fitzgerald said he was called to the house on the Monday, and treated deceased for a fractured left leg. When witness called again on Wednesday morning deceased complained of pain above his heel, and so a readjustment of the splint was made. Witness then went on to relate how he was called to the house the same night and how he arrived just as deceased collapsed. He could not form a definite opinion as to the cause of death.
To Mr. Hanlon: Until he examined the leg he was surprised to find the man back from the hospital so soon after the accident. He agreed that it would be impossible to know whether or not the veins were lacerated.
Couldn't the leg have been X-rayed before he left the hospital? — No. The X-ray plant was not working.
Oh, I see. It was going to be in working order after the man died? — It would have been X-rayed had the plant been in order.
Would an X-ray disclose blood clots in the vicinity of the injury? — No. It would show nothing but the fracture.
AMBULATORY TREATMENT. Would you term it a prudent thing to send a man with a fractured shin bone out of the hospital roughly 48 hours after receiving the injury? — Some medical men, believe in the ambulatory treatment, while others believe in keeping the patient in bed.
Do those gentlemen who believe in ambulatory treatment think that a man with an injured limb should start exerting himself within 48 hours of the injury? — personally I wouldn't order that.
Is embolism looked upon as a real risk in cases of simple fractures? — No.
But the medical school who follow the ambulatory treatment run the risk of suddenly killing the man? — Yes, remote as the risk is.
It doesn't seem to be too remote. This man died of it. Would the pain suffered by him on the journey home cause him to perspire in the manner described by his wife? — Yes.
Do you think it a prudent thing to send a man home in that condition and subject him to such pain? — No. Not walking. It was hard to say whether, if the man had been taken home in the ambulance, he might not have had that embolism.
The X-ray plant was out of order. I suppose the ambulance was out of order, too!
Witness went on to say that it was a fairly recognised practice among surgeons that a man could be got out of bed even on the second day of the fracture in many cases. The risk of embolism in simple fractures was almost negligible. The symptoms of embolism would show almost immediately after the detachment of the part of the clot which went to the lung.
Mr. Hanlon: If part of the clot becomes detached it goes straight, up to the lung and kills a man there and then? — It takes only a few seconds, and it was always immediate.
"LIVED JUST 'ROUND THE CORNER." Dr. Mary Anderson Champtaloup said she was house surgeon at the hospital and had treated deceased, the fracture being put up in the presence of Dr. Fergus. The usual treatment for fractures was given, and in the way the leg was put up witness did not think it was possible for embolism to be caused at the site of the fracture in the course of the man's journey home. The house surgeon followed the directions of the honorary surgeon, but if a case had any peculiarities she could offer a suggestion to that official.
Mr. Hanlon: Is this ambulatory treatment evolved from the point of view of the patient or because of the scarcity of beds? — The patient's bed was not required. I thought his Home was closer to the hospital than it later proved to be.
Is it not usual to give a man a strap to go round the shoulders and under the foot to help bear the weight of the injured leg? — It is sometimes done, but I have seen dozens without it.
Yes, the man would probably be safer in a vehicle. Don't you think it would have been more prudent to have had the leg Xrayed before his discharge? — No. I don't think so.
Well, what is the good of X-raying those fractures at all in that case? — The photographs are of academic, interest and some times it is necessary to see what displacement is present, and later to ascertain whether the correct manipulation has been carried out.
A hospital without an X-ray plant is not much of a hospital, is it?— Possibly not. The X-ray is certainly of great assistance.
To Dr. Falconer: An X-ray would have been taken in a fortnight. It was of no use to discover an embolism.
The Coroner: Did you ask deceased where he lived? — Yes, and he said: "Just round the corner." She thought the sister was acting quite properly in saying that he would be all right without a conveyance.
Would the sister know how far he had to walk? — I don't know.
Then how could she act properly in giving such advice when she didn't know where he lived? — She would probably inquire.
Doesn't that seem somewhat loose? Don't you think it would be a more proper practice to inquire for information much more definite and accurate? — Probably it would be wiser.
"I ADMIT IT WAS NOT RIGHT."
Dr. Alexander Robertson Falconer, medical Superintendent at the Hospital, said the X-ray plant was out of order for four days. The patient would be discharged by the house surgeon on the authority of a member of the honorary staff. He thought the question of a man getting home after discharge would be a matter for conversation between the house surgeon and the sister in charge of the ward. He.understood that this particular patient said he lived just round the corner.
Mr Hanlon: Are all fractures X-rayed? — Yes.
Then, why was this man not X-rayed? — Because the plant was out of order.
Why was he not kept in the Hospital till after an X-ray was taken? — In the case of such a fracture the bones were just under the skin, and the position of the bones could easily be ascertained by outside examination.
Do you think it was proper to send him out on crutches without knowing where he lived? — No. I admit that it was not right. The man had said, however; that he lived just round the corner.
But you had his address in the Hospital records. — At the Hospital in West London, where I was trained, such cases were not taken in at all. The fractures were simply put up in plaster at the door.
What do they do? Do they crawl home? — Conveyances are secured for those living any distance from the hospital.
Could this man not have had something to keep his foot off the ground? No. It isn't absolutely necessary.
It took him over an hour to go 300 or 400 yards. Don't you think that would be a help to him? — That distance was too much, and I am disappointed to think that this was done.
THE CORONER'S COMMENT. The Coroner said that the circumstances of the actual accident, which had this unfortunate and unforseen end, were perfectly clear, and the post mortem cleared up the medical position and showed the cause of death. "A considerable part of the inquiry has been taken up by the treatment and manner of discharge of such cases at the hospital. The medical superintendent wisely didn't attempt to justify the fact that a man with a fractured leg was discharged from the institution within 48 hours of the occurrence, to walk to his home — a distance of 300 or 400 yards. The weight of medical evidence showed that such a circumstance did not have any bearing on the ultimate result, but it is very unfortunate that such a state of things came about. The man suffered a considerable amount of pain on his way home, and the responsibility for that rests with the hospital authorities. There is evidence of a looseness in the system of discharge. The house surgeon stated that she and the sister understood that the man lived just round the corner, but I can't accept that position. The statement 'just round the corner' is a loose and indefinite one. Actually, the address was available on the hospital records. It should be the duty of a responsible medical officer to attend to the propriety of discharge. The position is more unfortunate in view of the rather humble circumstances of the man and his wife. She inquired about securing a conveyance, but was assured it would be all right. Others in a better position might have secured a conveyance on their own initiative; but one could hardly expect people of their circumstances to do so. It is unfortunate that this matter has cropped up and it is hoped that the question of discharge will now be more closely attended to. I must say that the circumstances of the discharge of this .patient were, to say the least, casual. It is fortunate that the medical evidence shows that it had no direct bearing on the man's death."
A verdict was returned in accordance with the medical testimony. -NZ Truth, 2/8/1924.
No comments:
Post a Comment